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The Experimental Sgudy on Payment System for Reimbursement to Medical Institutions

医疗机构报销支付制度的实验研究

基本信息

批准号：
10630062
负责人：
INAGAKI Hideo
金额：
$ 2.56万
依托单位：
Yokkaichi University
依托单位国家：
日本
项目类别：
Grant-in-Aid for Scientific Research (C)
财政年份：
1998
资助国家：
日本
起止时间：
1998 至 1999
项目状态：
已结题

来源：
https://kaken.nii.ac.jp/grant/KAKENHI-PROJECT-10630062/
关键词：
payment system for reimbursement fee-for-service payment system prospective payment system econometric method experimental economics supply of treatments medical institution selection computer network system 医療報酬支払制度医療経済実験包括支払制度出来

项目摘要

The reform of payment system for reimbursement to medical institutions in U.K. and U.S. carries on in the direction where U.S. with fee-for-service payment system (FFS) introduced prospective payment system (PPS) and U.K. with PPS introduced FFS. The two countries efforts to search for a set combined adequately two kinds of these. If medical institution is motivated to maximize their profits, the theoretical verification about workings of the payment system has the result that PPS may causes the under-supply of treatments and FFS causes the over-supply.Empirical studies about effect which the reimbursement was changed is verified by econometric method. But precise conclusions are not given by difficulty of medical data collection. We verify the theoretical result by the method of experimental economics that does not need existing data. In the experiment assuming the profit maximization in the medical institution, the over-supply was not caused. Statistical testing to our experimental d … More ata suggests that most of medical institution subject concerned more for patient subject's benefits than for their self-profits. Judging from the result of our experiments, we can expect that the introduction of PPS does not cause drastic fall in treatments.Because the medical institution selection by patients was impossible in the theory model used by the above-mentioned experiment, we expanded it to a dynamic model, which patients can be free to select a medical institution. The main result is the following. Medical expenditures fell greatly just after switching from FFS to PPS. But it converges in almost the same as medical expenditures under FFS with progress of the selection.This result is examined by the computer network system based on the method of experimental economics. This experiment demonstrates the validity of theoretical result. That is, when the treatment of the medical institution visited by patients and the average treatment were already known, the result to equalize the treatment under PPS by the patient's free selection based on the discrepancy between the two. Now, we are making an articles about this result. Less

英国医疗机构报销制度的改革而美国则是沿着按服务付费制（FFS）的美国引入未来付费制（PPS）和英国引入未来付费制（PPS）的方向进行的。PPS引入了FFS。这两个国家的努力，以寻求一套充分结合这两种。在医疗机构追求自身利益最大化的情况下，对支付制度运行机制的理论验证表明，PPS可能导致治疗供给不足，而FFS可能导致治疗供给过剩，并通过计量经济学方法对补偿方式改变的效果进行了实证研究。但由于医疗数据收集的困难，无法给出准确的结论。本文采用实验经济学的方法对理论结果进行了验证，该方法不需要现有的数据。在假设医疗机构利润最大化的实验中，没有出现供过于求的现象。对我们的实验数据进行统计检验 ...更多信息 ATA表明，医疗机构主体大多数对患者主体利益的关注程度高于自身利益。从我们的实验结果来看，我们可以预期PPS的引入不会导致治疗的急剧下降，因为在上述实验所使用的理论模型中，患者选择医疗机构是不可能的，所以我们将其扩展为一个动态模型，患者可以自由选择医疗机构。主要结果如下。从FFS转换为PPS后，医疗支出大幅下降。但随着选择的进行，它收敛到与自由现金流下的医疗费用几乎相同的水平，这一结果通过基于实验经济学方法的计算机网络系统进行了检验。实验验证了理论结果的正确性。也就是说，当患者访问的医疗机构的治疗和平均治疗已经知道时，根据两者之间的差异，通过患者的自由选择，在PPS下使治疗相等的结果。现在，我们正在做一个关于这个结果的文章。少